Provider Demographics
NPI:1588984447
Name:ILUMINADA'S ASSISTED LIVING HOME
Entity type:Organization
Organization Name:ILUMINADA'S ASSISTED LIVING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILUMINADA
Authorized Official - Middle Name:LINGAD
Authorized Official - Last Name:IBAY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-868-2738
Mailing Address - Street 1:7430 RANDAMAR PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5720
Mailing Address - Country:US
Mailing Address - Phone:907-868-2738
Mailing Address - Fax:907-868-2738
Practice Address - Street 1:7619 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4814
Practice Address - Country:US
Practice Address - Phone:907-868-2738
Practice Address - Fax:907-868-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100681347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle